克莱因派分析师处理投射性认同技术之情感与幻想
作者：Robert Waska 翻译：胡尚伟
在对投射性认同进行有效地分析的时候，，一些克莱因派分析师把投射性认同中所包含的情感和幻想当作关键因素考虑。
Herbert Rosenfeld (1952a) wrote of his work with psychoic patients who used PI as a way to grapple with severe paranoid-schizoid anxieties. Techniqucally, he believes in interpreting the primary phantasy associated with the anxiety. He writes of his work with one patient:
赫尔伯特罗森费尔德写文章介绍过他与使用投射性认同努力应付偏执分裂焦虑的病人的工作。从技术上讲，他认为要解释病人额原始幻想及相关的焦虑。他这样写道：
我向他解释说他不仅害怕从他内部取出坏的东西，而且也害怕从中取出好的东西，好的橘子汁和好的解释。因为他担心这会让他感到内疚。当我这么说的时候，他的身体震颤了一下；他发出呻吟声表示理解，他的面部表情也发生了改变。分析结束的时候，他喝光了杯子中的橘子汁，他这两天的主要事物或饮料…
In describing his work with another patient, Rosenfeld (1954) states:
关于罗森费尔德与另一个病人的工作，他这样写道：
我解释说她已经把我投射成她，她觉得我就是她，我必须为她说话为她着想。我想这就是为什么来到我的工作室后觉得自己被锁在了里面和为什么想要逃开我的原因。她现在看起来舒服多了，也能够信任别人了，说：“你是这个世界上最好的人”。我向她解释这是因为她觉得我是太好了她想把我内化，想拥有我的好的地方。这些解释之后…她有能力让自己脱离我，这会缓解她的困扰。她渐渐意识到我是一个外部客体，也能够和讨论…
In both these cases, Rosenfeld directly addresses the primary phantasies within the here-and-now analytic situation. Part of his PI interpretation concerned the erasing of self/object differentiation. This fading of boundaries is typical of PI, especially when used excessively, in a defensive posture. This pathological overuse of PI is common with more disturbed patients and is often part of the death instinct’s effort to destroy any distinction between self and object. When Rosenfeld interpreted his internal strategy, the patient could begin to discern what was separate from her ego and in the external world.
在上述两种情况下，罗森费尔德直接处理此时此地分析情境下的原始幻想。他对投射性认同的解释的一部分聚焦在消除自体和客体之间的区别。这种界限的模糊正是典型的用来防御的投射性认同，尤其使用过度的情况下。这种使用过度的病理性投射性认同在比较严重的病人那里用的很普遍，这是病人死本能努力破坏任何自体和客体之间区别的表现。当罗森费尔德解释这种内在的机理的时候，病人能够逐渐地识别出她的自我与外部世界的区别。
In 1990, Herbert Rosenfeld wrote of several clinical experiences with PI, again involving psychotic patients. Along with other material, a Mr A told him that he had been up all night worried that he might drown from water that could come flowing out of the sink. He had kekpt checking to see if the stoopers were in place. The analysis was about to be interrupted by the analyst’s two-week trip. Rosenfeld writes:
1990年，赫尔伯特罗森费尔德再次写过与精神病人工作时的几个严重的投射性认同的临床经验。根据其他的一些材料，A先生告诉他他整夜都在担心他也许淹死在从水槽里溢出来的水中。他一直在检查水阀是否关好。这个分析由于分析师两周旅行假期将要被打断。罗森费尔德这样写道：
我向他解释说，当他觉得他获得了改善并了解到我要和他分开，他突然克服了不耐烦和对我与其他男人的嫉妒，这些男人和我都是活跃的，可以四处移动。我指出，这是他把嫉妒部分转化成了对我和其他男人的认同从而接收了他们的力量和活力，使用这种方式，他的全能感部分使他相信他能够立即成熟和健康。
The patient responded by saying he was bothered at having to listen to such ridiculous voices in his head pushing him to dominate others when he knew better.
病人反馈说，当他有了更多的了解后，在他的头脑中听到非常荒唐的声音要他控制其他的人，这时他就不耐烦了。
罗森费尔德（继续）写道：“我向他解释说，令他害怕的分离促使他产生突然长大和独立的愿望，用这样的方式来应付与我分离的焦虑。” 这个病人继续谈论他如何感受到他的没有电的电视来阻止自己。他说，同样的原因，他每天不能起床。 他说他感觉他像是一个寄生虫。
I pointed out that he felt angry with that part of himself which stimulated him to get inside external objects … and also into internal objects which were represented by his bed. I stressed that at first he felt he probably could control and posses objects entirely when he got inside them, but very soon he felt enclosed and trapped and persecuted, which roused his wish to destroy the bed and the television screen which had turned into perscuting objects.
罗森费尔德（继续）写道：
我指出他对他自己的某一部分感到生气，因为这部分驱使着他进入到外部客体的内在里面…和他的床所代表的内部客体里面。我强调说，起初他觉得，如果他进入到那些客体里面，他很可能能够控制并完整地拥有他们，但是很快，他感觉到被困住了，陷入了困境，并感受到迫害，这激起他要破坏他的床和他的电视屏幕的愿望，此时床和电视屏幕变成了迫害性客体。
在下次分析一开始，病人就说他感觉好多了。但是，后来他说他感觉很不安，因为他始终意识到他对犹太人所拥有的深深地恨意。他说他们只要钱，他想攻击他们、惩罚他们。所森费尔德继续写道：我解释说…他对我感觉糟糕是因为，昨天分析之后他已经把他自己贪婪的寄生虫式的利用（自私）的部分从他自己身上拿掉了，放在了我的身上。他现在觉得我已经变成了他那个贪婪利用（自私）自体并且这让他对我感到强烈的怀疑。
The patient said he was frightened that the analyst must now hate him, and felt that the only way out was to destroy himself and that dreadful part of himself. 病人说他很害怕分析师现在会恨他，他觉得解脱的唯一方式就是攻击他自己和他自己那可怕的部分。
I interpreted his fear of my relation because when he saw me as a greedy, exploiting Jew he attacke and depised me, and feared that I would hate him because he believed I could not fear that he had pushed his own greedy self into me, not only as an attack but because he coul not bear it himself and wanted to get rid of it. I suggested that it was when he felt that I could not accept his bad and hated self that he attacked himself so violently … he calmed down considerably after the interpretations.
罗森费尔德继续道：
我向他解释了他对我们关系的恐惧，因为他把看作一个贪婪自私的犹太人他攻击并看不我，他害怕我会恨他因为他认为我不能承受他把他自己贪婪自私的自体放在我身上，不仅仅作为一次攻击而且因为他自己无法承受这种攻击，他想摆脱它。我认为，正是因为他觉得我不能接受他坏的恨的自体所以他才攻击如此暴力地攻击他自己…解释后他变得很冷静。
Overall, Rosenfeld showed this patient the intimate details of how his PI phantasy made the analytic relationship unsafe, unpredicatable, and unsatisfying. Rosenfeld’s interpretations explicated the elements of loss, paranoia, and guilt. Also, his comments offered this patient an inherent clarification of reality. All these interpretive approaches to PI helped reduce the patient’s psychotic tensions.
总的来说，罗森费尔德向病人展示了他的投射性认同幻想如何使得分析关系变得不安全、无法预测和不满意的内在机制。罗森费尔德的解释涉及到了丧失、妄想和内疚这些因素。他的解释也向病人对现实做了一种内在的澄清。所有这些投射性认同解释方法都有助于缓解病人的精神病性压力。
The material illsutrates how Rosenfeld’s PI interpretations focus beatifully on the details of the patient’s unconscious phantasies and the affects that accompany them. Because he is so in tune with the patient’s fears and hostilities, the interpretations have a secondary non-explicated benefit of addressing the pathological splitting and loss of ego boundaries in this patient. 这些案例说明了罗森费尔德的投射性认同解释如何出色地聚焦于伴随着病人的无意识幻想和情感。因为他如此地同调于病人的恐惧和敌意，他的解释获得了一个非解释性益处：指出了在病人身上出现的病理性分裂和自我界限的丧失。
Mario Pacheco de A. Prado (1980) discusses work with a psychotic patient who hardly ever said no to anything in life, which made him easy to be with and pleasing to others. However, he felt overwhelmed by personal failures in life and disorganized to the point of not functioning in daily living. During the second week of psychoanalysis, the patient was talking about how he spent the weekend thinking of the analyst and the wonderful feeling of closeness he had with him. Then he talked of feeling overcome by laziness and exhaustion. He tried to call someone for support. While he failed to reach anyong, he felt better for a while but then succumbed to the exhaustion. The patients felt “ as though I were full of cracks and I were leaking out of one, out of another, and when the time comes to do something, there is no more water!”(de A. Parado 1980:161).
普拉多讨论他与一个精神病患者的工作。这位患者几乎不能对生活中的任何事情说不，这让他和他人相处起来比较舒适，愉快。但是，他被他生活中失败和日常生活中的功能紊乱所压倒。分析进行到第二周，病人讨论他如何度过周末，他想着分析师和他与分析师在一起时他所拥有的美妙的亲密感觉。然后他谈到了他被懒惰和疲惫打败的感受。他努力给所有人打电话寻求支持。当他一个人也没联系到时，有一会儿他感觉好多了但是接下来却是疲劳殆尽。病人感觉“我好像充满了裂缝，我是从一个人又一个人那里漏出来的，当时间起作用的时候，再也没有水了！”
The analyst made an interpretation of the PI, “ you are spilling into me your aspects of mood, of ill, and you feel emptied of yourself and as if what you did were ordered by me.”
这个分析师做了投射性认同解释，“你把你的情绪和疾病都像水一样溢出来进入到了我的身体里，你感觉清空了自己，而且你做的这些都像是来自于我的命令。”
The patient replied:
Why do you say it is you who gives me orders …. Isn’t it myself? I telephoned a lot of people, I pinched myself to wake up and it was good, but I don’t feel I am making a choice. I keep on calling, and whoever I find first is the one I invite. Sometimes I hope secretely not to get anyone and so I calm down. I carry out what I feel responsible for and so I can rest. （de A. Prado 1980：161）
病人反馈说：
为什么说是你发命令…难道不是我自己吗？我打电话给很多人，我让自己疲劳地睡着了，这是好事啊，我没感觉到我做选择。我继续打电话，先找到谁就邀请谁来。有时候我暗自希望谁也找不到，我安静下来。我做了我能做的，那么我就可以休息了。
De A. Prado writes:
He refers to the anxiety experienced at the weekend with an allusion to his feeling himself full of cracks by which his impulse, his interests, escape … although he is leaking like water from a container full of cracks, he tried to defend the analyst from the feelings of the hate he experienced when [ the analyst was unavailable]. He inserted the “good” analyst among those he sought to reach by phone … the analyst was indeed inaccessible … what resulted … was the distress, the frustration, and the threat of desperation … unable to contain those sentiments for him … The analyst interprets the projective identification in the telephone spilling out into the analyst, of being swallowed by the analyst and becoming his puppet, without options. (de A. Prado 1980：161)
普拉多写道：
他谈及了周末体验到焦虑，同时伴随有一种幻觉，他感觉自己满身都是裂缝，如他的冲动、他的兴趣，他的逃离…尽管他像水一样从一个充满裂缝的容器里流了出来，但他仍然尽力保护分析师不要收到他所体验到恨，因为他渴望分析师，而分析师无法获得。他把好的分析师也放在了他打电话努力联系的那些人中…分析师确实是无法获得…结果就是…是压力，是挫折，是绝望的威胁…无法容纳针对他的那些情绪情感… 分析师解释了包含在电话号码、女孩和那次分析中展现的恐惧、要流入分析师以及被分析师所吞噬并毫无选择成为他的木偶等移情关系里的投射性认同。
The analyst directly interpreted the PI, translating the patient’s phantasy into elements of desire, fear, and defense. This is a focus on the intrapsychic meaning of the PI mechanism, rather than a focus on the interpersonal. Therefore, it has both the timelss quality of the patient’s phantasy and it matches with each component of the phantasy. De A. Prado also shows the patient what affect he is struggling with in regard to bth paranoid-schizoid and depressive delusions.
这个分析师直接对投射性认同进行了解释，把病人的幻想翻译成了欲望、恐惧和防御等因素。这种投射性认同机制是聚焦于单个人的内心，而不是聚焦于人际间的。因此，这种投射性认同有两个特点：病人的幻想没有时间性，和与幻想中每一部分都匹配。普拉多也向病人说明了他所纠缠的情感状态与偏执分裂和抑郁幻觉都有关。
I think this illusion of technique also shows one of the problems in the literature on PI. De A. Prado’s description of his intervention is somewhat vague. While he does interpret the primary phantasy involved in the PI, one is left wondering what exactly did he say to the patient and how exactly did the patient respond. Since the reader isn’t privy to the actual exchange, there is a question of how he got from A to B in his interpretation. This type of global reporting is common in the literature and makes it difficult for the reader to really examine, evaluate, and learn about the analyst’s technical appraoch.
我认为，这种解释技术在投射性认同相关文献中也暴露一个问题。De A. Prado的干预性描述有些模糊。他确实解释了包含在投射性认同中的原始幻想，让人好奇地是他究竟对病人说了什么和病人又究竟是如何回应的。由于读者没有参与到实际的交流，那么就有一个问题，在他的解释中，他如何从A到B的。这种整体性报告在文献中很是普遍，这也就使得读者难于仔细地查阅、评估和了解分析师的技术方法。
My aim is to first show the bulk of the literature that provides the clearest and most concise examples of verbatim interpretations in the PI clinical situation. Then I will show how I make interpretations of PI with my own patients in the clinical moment.
我的目的是首先展示大量文献，这些文中提供了在临床情境下对投射性认同进行逐字解释的最清楚和最简洁的案例。然后，我会展示在临床情境下我如何对我自己的病人进行投射性认同解释的。
Paula Heimann (1956) believes the use of interpretations in the analysis of PI is vital to the treatment, along with proper use of the countertransference. She wrties:
The therapeutic task of extending in the patient’s conscious knowledge about himself, about his unconscious impulse and defenses and anxiety and pain, makes it necessary to bring his unconscious phantasies to conscious … When the analyst express these … in his interpretations, the patient’s ego makes contact with them and so discovers something which is in reality its own, although he was unable to verbalize these phantasies or can remember only fragmentary flashes of such feelings or ideas flitting through his mind at some former time … words are of the greatest signicance, because they remove the barriers between the different strata of the ego, they promote clear and critical thinking, and they are the vehicle of conscious, explicit communication between patient and analyst … necessary if analysis is to bring about the patient’s fuller understanding of himself. (Heimann 1956:306)
Clearly, transformation of unconscious affect and phantasy is the goal that guides her PI interpretations.
波拉海曼认为，在投射性认同的分析中，结合反移情的合适使用，解释的使用对治疗是重要的。她写道：
治疗的任务是，扩展病人对他自己，他的无意识冲动、防御、焦虑和痛苦等意识层面的了解。这种治疗任务使得把无意识幻想带入意识中来成为必要…当分析师表达这些…在他的解释中，病人的自我与它们接触，然后发现一些它自己的真相，尽管他不能逐字地记起这些幻想或他只能回忆一些诸如在之前头脑中闪过的这类感觉或想法的片段…语言是最重要的，因为他们移除了自我不同层面的障碍，他们有助于清晰和批判性思考，他们是病人与分析师之间意识层面清晰交流的工具…如果分析是为了让病人更充分地理解他自己，这是必要的。
把无意识情感和幻想清楚地转变出来是波拉海曼对投射性认同进行解释的目标。
摘自 《临床中的投射性认同》（ "projective identification in the clinical setting" by Robert Waska)
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